During a BBL, how can a fat embolism be prevented?

Fat embolism will always be a risk when conducting a BBL. That being said, they are very rare. Fat injection can happen two different ways; injection into the gluteus muscle and injection into the existing buttocks fat. The gluteus muscle is what contains the blood vessels your plastic surgeon will want to stay away from, and there are several techniques he will use to do so. First his grafting instrument should be tipped with a blunt end, with the hole releasing the tissue on the bottom end of the tip - the blunt edge allows the tool to move blood vessels out of the way instead of puncturing them. Secondly all tissue deposits are done superficially; which means the tissue is injected on top of the layers already there, instead of deeper inside the fat and muscle layers. Lastly, the surgeon should employ a retracting motion with his tool while injecting the tissue - keeping him clear of any blood vessels even further. I suggest finding a board certified plastic surgeon that has plentiful experience in BBL's. Consult with him or her and I'm confident you will feel at ease. They are rare. SAFETY and more SAFETY is every surgeons top concern. Best wishes. 

Injecting above the muscle is likely safer and has less risk for this particular complication.Kenneth Hughes, MDBeverly Hills, CA.......

This is a very important question to ask your surgeon as this can be potentially fatal complication from BBL. There are multiple kinds of embolism. The two we are most concerned with are fat and venous emboli. To prevent venous emboli, the first key is to find a qualified plastic surgeon for your procedure. Discuss any personal or family history of blood clots and bleeding issues. Before and during your surgery, ensure that sequential devices and compression stockings are on your legs. After surgery make sure that you keep the compression devices on and move frequently. Your surgeon may decide to place you on a low dose aspirin or blood thinner.Regarding fat emboli, again choose a qualified surgeon. There is little that you can personally do to avoid fat emboli as this is a by-product of the fat re-injection technique. I personally believe that using larger cannula's with low dose injections help avoid this problem (the veins are smaller than the injection cannula which helps avoid inadvertent intravenous injection). 

There was an article that came out last summer in the white journal (main journal for plastic surgery). The article discussed fat embolism with BBL and how it is more common in South America (Columbia and Brazil- ~7%) than it is here in the US. The consensus was that when you are aggressive with high volume fat injection and inject into all layers of the gluteus muscle along with the fat, there is an increased risk of a fat embolism. This happens when the deep layer of the muscle is injected because this is where the blood vessels are. Because of this article, it is less common here is the US to inject into the deep layer of the muscle. This means that less fat volume is injected and therefore the results are not as dramatic as they used to be.

Hello and thank you for your question.  There is a risk of fat embolism with BBL, but there are several strategies to help minimize this risk:1) Go to a Board Certified Plastic Surgeon with expertise in advanced body contouring techniques2) Knowing your anatomy and not injecting near the gluteal veins3) Using large bore blunt cannulas to decrease your chances of inadvertently cannulating vessels that can embolize (also helps decrease trauma to the fat and thus allow for better fat survival percentages)4) Not injecting a large bolus in one area and continuously moving the cannula5) Using top of the line equipment6) Operating at a hospital where board certified anesthesiologists are giving you anesthesia and emergency personnel are available should an untoward event occurThe above list is not all inclusive but is a good start.  I hope this helps and good luck!Sincerely,Dr. Sean Kelishadi

I like to inject the buttocks perforators(large blood vessels that deliver blood to the bottocks cheek, with local anesthetic solution so that they will constrict and avoid inadvertent injection of fat into the vessels.